Obstetric Emergencies Flashcards
What happens in APH?
Bleeding from anywhere in genital tract after 24th week
Causes: Low lying placenta, Vasa praevia, Minor/major abruption and infection
What happens in Low Lying placenta?
Placenta that implanted into lower segment, may cover full or part of praevia
- Diagnosed at 20W USS, rpt 32W USS to confirm if low lying
How is LLP managed?
Avoid intercourse, present if bleeding/pain
- Admission if recurring bleeds
- Elective LSCS at 37/40
What happens in Bleeding placenta praevia?
A-E, Examination, Foetal Monitoring + Delivery, Steroids if <34 weeks
Major Bleed: 2x 14/16 G cannulas, IV fluids, X match 6 units and inform senior team
Describe Vasa Praevia
Foetal Vessels throughout membrane coursing over internal cervical OS and below foetal presenting part, Major foetal risk with Haemorrhage, CTG abnormalities
How do you manage AIP?
Look at 20W scan for anterior LLP if previous CS
- Loss of definition between wall of uterus and abnormal vasculature
- Possible interventions: Hysterectomy, leave placenta in place, cell salvage, IR
- Elective CS at 36-37W
MDT approach
Describe Placenta Abruption?
Premature separation of placenta from uterine wall from baby
- Foetal distress and maternal shock potentially
Tense woody, hard uterus and emergency
What complications can occur following APH?
Premature labour/delivery, Blood transfusion, Acute tubular necrosis, DIC, PPH, ITU or ARDS
Describe parts of Severe Pre-Eclampsia
- Hypertension and Proteinuira +/-
- Severeheadache, Papilloedema, Clonus, Liver Tenderness, Visual Disturbances, Abnormal Liver enzymes and Platelet count declines
How is Pre-Eclampsia managed?
1) Stabilise BP e.g. Nifedipine, Labetalol
2) Check Blood inc FBC, platelets, Renal and Liv function
3) MgSO4
4) Monitor urine output e.g. Fluid restrict to 80 mls/hour
5) Treat coagulation defects
6) Foetal Wellbeing (CTG, USS for growth)
7) Delivery!
Describe Eclampsia
Onset of seizures in Woman with Pre-Ec (Always until proven otherwise!)
How is Eclampsia managed?
IV MgSo4 over 5 mins, followed by 1g/hour maintained for 24h
Recurrent seizures need further doses
- Treat Hypertension (Labetalol)
(STABILISE Mum first then DELIVERY baby!)
How should Sepsis be managed?
Advise pregnant women to be immunised for flu and covid
- SEPSIS 6 O2, Bloods, IV Abx, IV Fluid, HB and lactate, Measure hourly urine output
What are the maternal RF for Sepsis?
Obesity, Diabetes, Impaired immunity, Anaemia, Vag discharge, Pelvic or Strep B infection Hx, Amniocentesis
What happens in Cord Prolapse?
Cord presents first, after rupturing membrane and exposure of cord –> Vasospasm with high chance of fetal morbidity and mortality
What are RF of cord prolapse?
Premature membrane ruptures, Polyhydramnios, Long UC, Foetal malpresentation, Multiparity
How is Cord Prolapse managed?
Infuse fluid into blader via catheter
Trendelenburg position
Constant foetal monitoring
Alleviate cord pressure
Transfer to theatre and be ready for delivery
What is Shoulder Dystocia?
Failure for anterior shoulder to pass under symphysis pubis after foetal head delivery
(Intrapartum Emergency)
What are the RF for SD?
Macrosomia, Maternal Diabetes, Previous SD, Mat and Foetal disproportion, Postmaturity, Prolonged 1st/2nd stage of Labour
How is SD managed?
HELPER
H: Call for help
E: Evaluate for episiotomy
L: Legs in mcroberts
P: Suprapubic Pressure
E: Enter pelvis
R: Rotational manoeveure
R: Remove post arm
(Replace head and deliver by LSCS)
What are the SD complications?
Foetal: Hypoxia, Fits, Cerebral palsy/injury to BP
Maternal: PPH, Extensive Vaginal tear and psychological
What is PPH?
1O: Blood loss >500mls within 24hrs
2O: After 24hrs up to 12 weeks, Minor 500-1000mls, Major >1000mls
What are causes of PPH?
4Ts
Tissue (Ensure placenta complete)
Tone Ensure utuerus contracted
Trauma: Look for tears
Thrombin: Check for clotting (RPC transfusion)
What are RF of PPH?
Big baby, Nulliparity, Multiple Pregnancy, Precipitate/prolonged labour, Maternal pyrexia, Operative delivery or shoulder dystocia, PPH hx
What are the managements of PPH?
Treat cause, surgery and Meds: Sytocinon, Ergometrine,, Haemobate, TXA
